Psychological Issues in Genetic Testing for Breast Cancer

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Reprinted with Permission From: Archives of Internal Medicine, 154:609-616.
Funded by AHCPR Grant HS06660
From No. 176, July 1994 Research Activities of the
Agency for Health Care Policy and Research, p. 28

Susceptibility

Although hereditary breast cancer (HBC) accounts for only about 5-10% of
all breast cancers, up to 25% of early-onset cases are attributable to
HBC. One of the greatest potential benefits of genetic tests for breast
cancer susceptibility is the identification of young women who may
benefit from mammogram surveillance initiated at an earlier age and/or
on a more frequent basis than usual.

Previous studies suggest that notifying persons about their risks for
cancer can have serious negative psychological consequences that may
impair adherence to prevention recommendations, either because of denial
or fear of discovering cancer. This poses unique challenges for genetic
counselors who must inform patients of their breast cancer risk based on
genetic testing results, according to the authors. They recommend that
genetic counselors provide patients with pretest counseling, ensure the
patient's informed consent before testing, be aware of and minimize
adverse psychological consequences, provide or arrange for followup
care, and promote breast cancer prevention and surveillance techniques.
The authors also caution that genetic information has implications, not
only for the individuals who undergo testing but also for their
partners, children, siblings, and parents and followup support should be
extended to family members as well.